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Gholamreza Pourmand , Mohsen Ayati , Ali Razi , Aliakbar Karami , Rashid Ramazani , Ayat Ahmadi , Parvin Akbari Asbagh, Rahil Mashhadi , Shadi Pourmand ,
Volume 73, Issue 5 (August 2015)
Volume 73, Issue 5 (August 2015)
Abstract
Background: Prostate-Specific Antigen (PSA), also known as gamma-seminoprotein or kallikrein-3 (KLK3), is the best marker for early diagnosis of prostate cancer. Since age and race are affecting PSA levels, determining age-specific reference ranges of PSA in every community is necessary for increasing the efficiency rate of PSA. The aim of the present study was to evaluate the normal distribution of total prostate-specific antigen (TPSA) and free prostate-specific antigen (FPSA) and determine age-specific reference ranges of PSA in Iranian men. Methods: In this cross-sectional study, 1200 normal men with the age range of 50 to 79 referred to Shahid Rajaie Hospital, Qazvin Province in Iran, from 2011 to 2013. After excluding patients with prostate cancer and urinary tract infection, 1020 men were included in this study. Then, their blood samples were collected and after the extraction of serum from blood, serum levels of FPSA and TPSA were measured using commercial kits the reference range of PSA was specified for each age group and compared with reference ranges of other populations. Results: The mean age of the patients was 61.03±7.5 years and the mean values of FPSA and TPSA were 0.47±0.6 ng/ml and 1.56±2.05 ng/ml, respectively. PSA serum levels (95th percentile range) in 50 to 59, 60 to 69 and 70 to 79-year age groups were 0-3.6 ng/ml, 0-5.7 ng/ml and 0-6.8 ng/ml, respectively. TPSA (r= 0.2, P< 0.001) and FPSA (r= 0.22, P< 0.001) were significantly associated with age. In addition, a significant relationship was found between TPSA serum levels and alcohol consumption (P= 0.017), smoking (P< 0.001) and family history of prostate cancer (P= 0.014). Conclusion: Findings of the present study showed that PSA levels are correlated with age. It was also revealed that the PSA age-specific reference range obtained in this study is different from other races and is specific to Iranian men. Therefore, age-specific reference ranges of PSA obtained in the present study can increase PSA test sensitivity and specificity by reducing unnecessary diagnostic procedures and early detection of prostate cancer in Iranian men.
Anousheh Safarcherati , Masoumeh Amin-Esmaeili , Behrang Shadloo , Minoo Mohraz , Afarin Rahimi-Movaghar ,
Volume 73, Issue 10 (January 2016)
Volume 73, Issue 10 (January 2016)
Abstract
HIV/AIDS is among the leading causes of morbidity and mortality in world. There are more than 35 million people living with HIV/AIDS in the world. Although the annual incidence of HIV infection is decreasing globally, HIV prevalence is rising due to development of more effective treatment and higher survival. Iran suffers from concentrated HIV epidemics among injecting and non-injecting drug users. There are more than 27 thousand registered cases of HIV infection and it is estimated that there are above seventy eight thousand cases in the country. Regarding the burden of disease, it is projected that HIV/AIDS will have the highest growth during the next 10 years. The outcome of this epidemics will be determined by human behavior. HIV, psychiatric disorders and substance use disorders are closely correlated and are accompanied by similar risk factors. They also share common consequences such as stigma and discrimination. Correlation of psychiatric disorders, as one of the most influential determinants of our behavior, and HIV/AIDS infection is reviewed in this narrative article. Psychiatric disorders are associated with greater risk of HIV acquisition. Substance use disorders, both injecting and non-injecting, as well as severe mental illnesses put the individual at higher risk of acquiring HIV infection. Impaired judgment, diminished inhibition and control over behaviors, lack of insight and poor self-care have been proposed as the underlying mechanisms. On the other hand, HIV infection may put the individual at greater risk of developing a mental illness. Coping with a chronic and life-threatening illness, fear of stigma and discrimination, CNS invasion of the virus as well as the adverse neuropsychiatric side effects of anti-retroviral medications may all contribute to establishment of a psychiatric disorder. Although there exists a bi-directional correlation between mental health problems and HIV/AIDS infection, this reciprocity goes beyond. Psychiatric disorders can affect the patient’s adherence, access to treatment and care and can worsen the course and clinical outcome of the infection. The clinical importance, underlying mechanism and other implications of this correlation are reviewed in this article.
Vahid Moslehizadeh , Farzam Ajamian , Ahmad Ebrahimi , Hossein Delshad Siahkali ,
Volume 73, Issue 12 (March 2016)
Volume 73, Issue 12 (March 2016)
Abstract
Background: The major issue to address in obesity etiology is to identify the genetic changes in the disease and their occurrence in different populations. Uncovering these genetic changes may be important in developing potential biomarkers for early diagnosis and prognosis of obesity. Among all obesity susceptibility genes studied before, convincing association has been found with variants in the FABP2 gene and this disease; however, the contributions of these genetic variants in different populations and ethnic groups are not similar. Accordingly, this study was carried out to replicate the previous findings to assess whether a missense variation (rs1799883) in this gene is associated with obesity in the Tehran Lipid and Glucose Study (TLGS) population.
Methods: A case–control study was designed to determine the possible association between rs1799883 and occurrence of obesity “in phase IV of the study between the years of 2008 to 2011”. The study group consisted of 217 subjects with body mass index (BMI, kg/m2) greater than 30 as cases and 159 healthy individual as control group (18
Results: The results showed no significant differences between case and control groups in terms of allele frequency (P=0.61). According to the findings, the presence of T allele as the risk allele was not associated with increased risk of obesity in carriers of this allele compared to individuals carrying the normal allele (OR=1.17; CI%95= 0.62-2.19, P=0.61).
Conclusion: The results did not support the previous findings of an association between genetic polymorphism in the FABP2 gene and risk of obesity. However, a number of replicated studies with other ethnicity are suggested to make a conclusion about the role of this genetic polymorphisms and susceptibility to obesity in Iranian population.
Hossein Fakhrzadeh , Mohamad Jafar Mahmoudi , Zahra Droudian, Farshad Sharifi , Yaser Tajalizadeh Khoob, Neda Mehrdad , Fatemeh Jafaraghaei , Zohreh Badamchizadeh ,
Volume 74, Issue 3 (June 2016)
Volume 74, Issue 3 (June 2016)
Abstract
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Background: The relationship between serum homocysteine levels and cardiovascular diseases has been elucidated since many years ago. In this study, the association between serum levels of homocysteine, folic acid, and vitamin B12 with the pulse wave velocity and Buckberg index or subendocardial viability ratio was assessed in individuals with diabetes and also non-diabetic subjects. Methods: In this cross-sectional study, 58 individuals with type 2 diabetes and 36 non-diabetic people, from April to October 2013 were enrolled in Dr. Shariati Hospital affiliated to Tehran University of Medical Sciences. Anthropometric and blood pressure measurements were performed with standard methods. Fasting serum glucose, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, Triglyceide, A1C, vitamin B12, folic acid and serum homocysteine levels as well as, highly sensitive complement-reactive protein (hs-CRP) were measured. Artherial stiffness was assessed by calculating pulse wave velocity and aortic agumentation index via Sphygmocor. In addition, Buckberg index (Subendocardial viability ratio) was assessed by dividing myocardial oxygen supply to dimand expressed as percent. The normality of distributions was evaluated by Kolmogorov-Smirnov test and linear regression models were utilized to detect associations. Results: Diabetic and non-diabetic subjects differed in terms of age, history of hypertension, serum levels of homocysteine, and LDL-C (P< 0.05). The pulse wave velocity in subjects with diabetes and without diabetes were 60.91 m/s and 41.91 m/s, respectively (P= 0.01). After adjustment for confounding factors in multivariate regression analysis pulse wave velocity was associated with age and homocysteine levels in non-diabetic group, (β equal to 0.441 and 0.345, respectively), and it was related to age, diastolic blood pressure and serum levels of c-reactive protein in subject with diabetes (β= 0.417, 0.302, and 0.262, respectively). Conclusion: Homocysteine levels in non-diabetic individuals were associated to sub-clinical atherosclerosis markers but we could not find this association in diabetic participants. |
Farid Suleimani Mohammadi , Abbas Rahimi Foroushani , Mohsen Rokni , Mohammad Farahmand , Kazem Ahmadi Kia , Azadeh Shadab , Hamidreza Ahmadkhaniha, Jila Yavarian ,
Volume 74, Issue 11 (February 2017)
Volume 74, Issue 11 (February 2017)
Abstract
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Background: Schizophrenia (SC) and bipolar disorder (BD) are two chronic psychiatric illnesses with worldwide distribution. People could be involved at any age, particularly in early adolescence. Main symptoms of SC are non- affective symptoms such as auditory hallucination and illogical thinking. In contrast, BD represents affective symptoms such as depression and mania. Although the main cause of these mood disorders has been remained elusive, there are some potential contributing factors that could be considered in the pathogenesis of mentioned illnesses including, genetic and environmental factors. Cytomegalovirus (CMV) is one of the probable contributing factors in SC and BD. CMV is a prototype of herpesviridae family which may infect different cell types such as endothelial and differentiated hematopoietic cells. CMV infections in immunocompromised patients as well as congenitally infected children represent CNS complication such as microcephaly and hearing loss. This virus has capability to impair the limbic structures in brain. Methods: This descriptive study was designed to evaluate the role of CMV in these illnesses. We investigated the level of serum IgG antibody and the presence of CMV DNA in serum and peripheral blood mononuclear cells (PBMCs) samples of 46 SC and BD patients admitted to Iran Psychiatry Hospital Tehran, Iran from 2014 to 2015 as well as 46 healthy control groups at Tehran University of Medical Sciences. First, the level of CMV IgG antibody was evaluated in serum samples, by enzyme-linked immunosorbent assay (ELISA). Then, DNA extraction conducted by using the high pure viral nucleic acid kit (Roche, Germany). Serologically positive sera along with PBMC samples were tested by Real-time PCR, to investigate the presence of CMV DNA. Results: Results indicated higher levels of CMV IgG antibody in psychiatric patients, compared with a healthy control group. Afterward, we did not observe the presence of CMV DNA in either case or control groups. Conclusion: According to the CNS impairment mediated by CMV infection, this virus has been supposed to play an important role in pathogenesis of mental disorders such as SC and BD. We suggest further investigation to be conducted, particularly on other samples such as cerebrospinal fluid. |
Shahram Seyfi, Ali Zahedian , Farshad Hasanzadeh Kiabi,
Volume 75, Issue 2 (May 2017)
Volume 75, Issue 2 (May 2017)
Abstract
Background: Postoperative pain is one of the most common complications following laparoscopic cholecystectomy. Because the majority of the analgesic drugs including opioids and nonsteroidal anti-inflammatory drugs have many side effects, using drugs with lesser side effects is beneficial. The aim of this study was to evaluate the effect of N-acetylcysteine on the pain after laparoscopic cholecystectomy.
Methods: In a randomized clinical trial, in two university-affiliated teaching hospitals in Babol City (Shahid Beheshti and Shahid Yahyanezhad Hospitals), Iran, from August 2015 to March 2015, a total number of 38 patients with age of 20-50 years, who were candidates for laparoscopic cholecystectomy with American Society of Anesthesiologists Class-I were chosen and randomly assigned into two groups. The night before operation, 1200 mg oral N-acetylcysteine is given to intervention group. Also, they received 600 mg IV N-acetylcysteine in the morning before operation. In the control group, two vitamin C effervescent tablets as placebo were given at night before operation and 3 ml sterile water as placebo was injected in the morning of operation. Amount of pethidine consumption and the changes in hemodynamic in two groups was recorded and analyzed at 24 hours after operation.
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Results: The average of patients age was not significant different between two groups (P=0.23). Average of pain score in placebo group was 3.5 and in N-acetylcysteine group was 2.7 that it was not significant difference between two groups (P=0.06). Average of pethidine consumption in placebo group was 52 mg and in N-acetylcysteine group was 29 mg in 24 hours, that the difference was statistically significant between two groups (P=0.01) Conclusion: As the results of the study, it can be concluded that the anti-inflammatory effects N- acetylcysteine can inhibit the function of lipoproteins and prostaglandins, reduced glutathione peroxidase and dismutase has been restored and can be used to treat pain or analgesic dose reduction. In this study the N-acetylcysteine has reduced pain after laparoscopy and analgesic dose of mepridine. |
Davood Azimpour , Nahid Tahan , Fereshteh Poursaeed , Farideh Dehghan Manshadi , Erfan Ghasemi ,
Volume 75, Issue 5 (August 2017)
Volume 75, Issue 5 (August 2017)
Abstract
Background: Spasticity is a clinical deficit of upper motor neurons lesions that presented immediately or at delayed times after lesions and occurs in about 38% of stroke patients. Extracorporeal shock wave therapy (ESWT) has been recently reported as a safe and effective method for reducing spasticity in stroke patients. In the present study, we sought to investigate the impact of the ESWT on post stroke spasticity using a meta-analysis method.
Methods: All primary reports of spasticity indexed in PubMed, MEDLINE, Science Direct, Scopus and search engine of Google Scholar from January 2000 to December 2016 were searched. The following terms were used as keywords: Spasticity, muscle hypertonicity, ESWT, stroke and hemiplegia. Any report was included if it met the following criteria: involving clinical trials, full-version availability, and being written in english. Two reviewers selected articles independently and reviewed the studies considering quality and eligibility, and then they extracted general information on objectives, design, participants, and outcomes. The methodologic quality of each study was assessed using the Pedro Scale. In the statistical analyses, we considered two outcomes; Modified Ashworth scale (MAS) grade and passive rang of movement (PROM). The meta-analysis was done using random effect model in Stata, version 11 (Stata Corp., TX, USA).
Methods: All primary reports of spasticity indexed in PubMed, MEDLINE, Science Direct, Scopus and search engine of Google Scholar from January 2000 to December 2016 were searched. The following terms were used as keywords: Spasticity, muscle hypertonicity, ESWT, stroke and hemiplegia. Any report was included if it met the following criteria: involving clinical trials, full-version availability, and being written in english. Two reviewers selected articles independently and reviewed the studies considering quality and eligibility, and then they extracted general information on objectives, design, participants, and outcomes. The methodologic quality of each study was assessed using the Pedro Scale. In the statistical analyses, we considered two outcomes; Modified Ashworth scale (MAS) grade and passive rang of movement (PROM). The meta-analysis was done using random effect model in Stata, version 11 (Stata Corp., TX, USA).
| Results: Eleven studies within a total of 261 patients were included in this review. In seven studies the shock waves were applied to the upper limb muscles, and in four other studies, the effects of ESWT on the spasticity of the lower limb muscles were assessed. Immediately after applying the ESW, MAS grade was significantly decreased in comparison to the baseline values. (Standardized mean difference [SMD], -1.62; 95% confidence interval [CI], -2.2 to -1.04). The PROM was significantly increased immediately after ESWT in comparison to the baseline values (SMD, 3.23; CI 95%, 1.35 to 5.12). Conclusion: The results of this study showed that ESWT can immediately improve the spasticity and increased PROM, but it seems that the mechanism of action of shock waves on spasticity is still unclear. Further clinical trial studies with higher methodological quality should be recommended. |
Razieh Nazari , Mehri Ghasemi , Farideh Dehghan-Manshadi , Alireza Akbarzadeh-Baghban ,
Volume 75, Issue 9 (December 2017)
Volume 75, Issue 9 (December 2017)
Abstract
Background: Sonography is used for measuring the muscle morphology including length, depth, cross-sectional area, bulk and pennation angle. The supraspinatus is the most common affected muscle among the rotator cuff muscles. There is no study about the reliability of sonographic measurement of supraspinatus thickness in the positions of empty can (EC), full can (FC) and hug up (HU) tests. The present study aims to investigate the intra-rater reliability of the measurement of sonographic thickness of supraspinatus muscle in the rest and positions of the EC, FC and HU tests.
Methods: The present study was a descriptive-analytic study which was carried out in a cross-sectional method on ten healthy women aged: 22.10±2.76 years without any tendon pathology. The study was carried out during four weeks (January to March in 2017). The supraspinatus thickness was scanned during rest and contracted states. The positions of measuring ultrasonic thickness of supraspinatus were as follow: position of EC test: the arm in 90-degree elevation in the scaption plane with the thumb-down, position of FC test: the arm in 90-degree elevation in the scaption plane with the thumb-up, position of HU test: the palm of hand was placed on the opposite shoulder with the elbow flexed using a 0.5-kg weight cuff. Intra-rater reliability of ultrasonic muscle thickness measurements were examined in one day.
Results: All intra-rater reliability values were equal or more than 0.90: the value was 0.90 (95%CI: 0.65-0.97) in the rest position, while for the measurement of ultrasonic thickness of the supraspinatus was 0.96 (95%CI: 0.87-0.99) in the position of EC test, 0.97 (95%CI: 0.90-0.99) and 0.96 (95%CI: 0.86-0.99) in the positions of FC and HU tests, respectively.
Conclusion: Measurement of ultrasonic thickness of supraspinatus muscle is a reliable method in the rest and positions of EC, FC and HU tests. This method can be used to compare the muscle thickness changes in the positions of the above tests.
Methods: The present study was a descriptive-analytic study which was carried out in a cross-sectional method on ten healthy women aged: 22.10±2.76 years without any tendon pathology. The study was carried out during four weeks (January to March in 2017). The supraspinatus thickness was scanned during rest and contracted states. The positions of measuring ultrasonic thickness of supraspinatus were as follow: position of EC test: the arm in 90-degree elevation in the scaption plane with the thumb-down, position of FC test: the arm in 90-degree elevation in the scaption plane with the thumb-up, position of HU test: the palm of hand was placed on the opposite shoulder with the elbow flexed using a 0.5-kg weight cuff. Intra-rater reliability of ultrasonic muscle thickness measurements were examined in one day.
Results: All intra-rater reliability values were equal or more than 0.90: the value was 0.90 (95%CI: 0.65-0.97) in the rest position, while for the measurement of ultrasonic thickness of the supraspinatus was 0.96 (95%CI: 0.87-0.99) in the position of EC test, 0.97 (95%CI: 0.90-0.99) and 0.96 (95%CI: 0.86-0.99) in the positions of FC and HU tests, respectively.
Conclusion: Measurement of ultrasonic thickness of supraspinatus muscle is a reliable method in the rest and positions of EC, FC and HU tests. This method can be used to compare the muscle thickness changes in the positions of the above tests.
Shadi Khazaei, Shahrbanoo Keyhanian , Mahila Monajati , Shahram Ala, Ebrahim Salehifar ,
Volume 75, Issue 9 (December 2017)
Volume 75, Issue 9 (December 2017)
Abstract
Background: Methotrexate (MTX) is commonly used in the hematology-oncology units and is frequently associated with adverse effects. High-dose methotrexate (HDMTX) is indicated in the treatment of acute lymphoblastic leukemia (ALL), osteosarcoma, systemic non-Hodgkin lymphoma and primary central nervous system (CNS) lymphoma. The side effect profile of MTX varies markedly according to dose. The aim of this study was to evaluate the uses and adverse effects of HDMTX in a cancer center in north of Iran.
Methods: This cross-sectional descriptive study carried out in Emam Sajjad Hospital, Ramsar, Iran from June 2016 to July 2017. Doses more than 500 mg/m2 of MTX was considered as a high-dose. Hydration status, evaluation of the renal and hepatic function, blood tests, urine pH, doses and frequencies of leucovorin administration, measurement of serum levels of MTX and side effects were evaluated. Recommendations of UpToDate 2017 were considered as standards of administration of HDMTX.
Results: Forty-four courses of HDMTX were evaluated in this study. HDMTX were prescribed for lymphoma (30 cases), ALL (8 cases) and osteosarcoma (6 cases). In all patients, hydration was done with 1340.9±894 normal saline plus 25 ml sodium bicarbonate 8.4%, one to two hours before HDMTX. The solution used for dilution of MTX was 5% dextrose (1022.7±105.5 ml). Urine pH was not measured in any patient. The frequency of leucovorin administration was 5.64±3.03 times with doses of 17.6±1.7 mg/m2 every 6 hours. Serum levels of MTX were not measured in any patient. Blood urea nitrogen and creatinine measurement was carried out before administration of HDMTX in all patients. The most common adverse effects were nausea (64.4%), anxiety (44%) and headache (43.2%).
Conclusion: The appropriate aspects of HDMTX usage were good hydration, urine alkalinization with bicarbonate and administration of leucovorin in patients receiving HDMTX, whereas monitoring of serum levels of MTX and administration of bicarbonate based on urinary pH were not done in any of the patients.
Methods: This cross-sectional descriptive study carried out in Emam Sajjad Hospital, Ramsar, Iran from June 2016 to July 2017. Doses more than 500 mg/m2 of MTX was considered as a high-dose. Hydration status, evaluation of the renal and hepatic function, blood tests, urine pH, doses and frequencies of leucovorin administration, measurement of serum levels of MTX and side effects were evaluated. Recommendations of UpToDate 2017 were considered as standards of administration of HDMTX.
Results: Forty-four courses of HDMTX were evaluated in this study. HDMTX were prescribed for lymphoma (30 cases), ALL (8 cases) and osteosarcoma (6 cases). In all patients, hydration was done with 1340.9±894 normal saline plus 25 ml sodium bicarbonate 8.4%, one to two hours before HDMTX. The solution used for dilution of MTX was 5% dextrose (1022.7±105.5 ml). Urine pH was not measured in any patient. The frequency of leucovorin administration was 5.64±3.03 times with doses of 17.6±1.7 mg/m2 every 6 hours. Serum levels of MTX were not measured in any patient. Blood urea nitrogen and creatinine measurement was carried out before administration of HDMTX in all patients. The most common adverse effects were nausea (64.4%), anxiety (44%) and headache (43.2%).
Conclusion: The appropriate aspects of HDMTX usage were good hydration, urine alkalinization with bicarbonate and administration of leucovorin in patients receiving HDMTX, whereas monitoring of serum levels of MTX and administration of bicarbonate based on urinary pH were not done in any of the patients.
Farshad Khodakhah , Talat Mokhtari Azad ,
Volume 75, Issue 11 (February 2018)
Volume 75, Issue 11 (February 2018)
Abstract
Before the recent outbreaks of Zika virus, few people have ever heard of its name. Even virologists had paid little attention to this member of the Flaviviridae family. Hence, up to January 2016, only 269 articles about Zika virus had been indexed in PubMed compared to the 9187 articles related to dengue virus. However, declaration of the World health organization (WHO) about the global Zika virus spreading, which has been associated with birth defects and some neurological problems, diverted more attention to this forgotten virus. Afterwards, the virus hit the headlines and became a research interest. Since then, up to 9 August 2017, the number of Zika related articles indexed in PubMed reached to 3214. Zika virus is a re-emerging arbovirus. The First detection of Zika virus was in Uganda in 1947. It belongs to the Flavivirus genus in the Flaviviridae family. Zika can typically cause a mild and self-limiting disease in a healthy person. However, in pregnant women, it might cause birth defects and occasionally it can be associated with peripheral neuropathy such as Guillain-Barre syndrome. Although many research have been conducted to find out the casual link between this virus and these disorders but this relationship is still dim and controversial. Considering its recent epidemics in 2015 and 2016 the geographical distribution of Zika virus seems to expand all over the world progressively. Interaction between virus and vector is dynamic. Variety of competent vectors and adaptability of virus to new arthropod vectors are the two major factors for this process. According to the last report published by WHO, 84 countries/territories in five continents have reported the circulation of Zika virus in their area. In the recent outbreak, WHO regional office in our region (EMRO) have reported no case of Zika virus transmission from this region. Nonetheless, because specific and competent vectors exist in some countries, this region has a potential of epidemic risk. Until now we have neither autochthonous nor imported case of Zika virus in our country but we should prepare for any unexpected situation. In this review, we will discuss new findings about the history, virological features, vectors, transmission routes and epidemiological aspects as well as laboratory diagnosis of Zika virus. In addition, the epidemiology of this virus in Iran will be discussed.
Hossein Ghayoumi Zadeh, Mostafa Danaeian, Ali Fayazi , Farshad Namdari, Sayed Mohammad Mostafavi Isfahani ,
Volume 76, Issue 1 (April 2018)
Volume 76, Issue 1 (April 2018)
Abstract
Background: One common symptom of diabetes is diabetic retinopathy, if not timely diagnosed and treated, leads to blindness. Retinal image analysis has been currently adopted to diagnose retinopathy. In this study, a model of hierarchical self-organized neural networks has been presented for the detection and classification of retina in diabetic patients.
Methods: This study is a retrospective cross-sectional, conducted from December to February 2015 at the AJA University of Medical Sciences, Tehran. The study has been conducted on the MESSIDOR base, which included 1200 images from the posterior pole of the eye. Retinal images are classified into 3 categories: mild, moderate and severe. A system consisting of a new hybrid classification of SOM has been presented for the detection of retina lesions. The proposed system includes rapid preprocessing, extraction of lesions features, and finally provision of a classification model. In the preprocessing, the system is composed of three processes of primary separation of target lesions, separation of the optical disk, and separation of blood vessels from the retina. The second step is a collection of features based on various descriptions, such as morphology, color, light intensity, and moments. The classification includes a model of hierarchical self-organized networks named HSOM which is proposed to accelerate and increase the accuracy of lesions classification considering the high volume of information in the feature extraction.
Results: The sensitivity, specificity and accuracy of the proposed model for the classification of diabetic retinopathy lesions is 98.9%, 96.77%, 97.87%, respectively.
Conclusion: These days, the cases of diabetes with hypertension are constantly increasing, and one of the main adverse effects of this disease is related to eyes. In this respect, the diagnosis of retinopathy, which is the same as identification of exudates, microanurysm and bleeding, is of particular importance. The results show that the proposed model is able to detect lesions in diabetic retinopathy images and classify them with an acceptable accuracy. In addition, the results suggest that this method has an acceptable performance compared to other methods.
Methods: This study is a retrospective cross-sectional, conducted from December to February 2015 at the AJA University of Medical Sciences, Tehran. The study has been conducted on the MESSIDOR base, which included 1200 images from the posterior pole of the eye. Retinal images are classified into 3 categories: mild, moderate and severe. A system consisting of a new hybrid classification of SOM has been presented for the detection of retina lesions. The proposed system includes rapid preprocessing, extraction of lesions features, and finally provision of a classification model. In the preprocessing, the system is composed of three processes of primary separation of target lesions, separation of the optical disk, and separation of blood vessels from the retina. The second step is a collection of features based on various descriptions, such as morphology, color, light intensity, and moments. The classification includes a model of hierarchical self-organized networks named HSOM which is proposed to accelerate and increase the accuracy of lesions classification considering the high volume of information in the feature extraction.
Results: The sensitivity, specificity and accuracy of the proposed model for the classification of diabetic retinopathy lesions is 98.9%, 96.77%, 97.87%, respectively.
Conclusion: These days, the cases of diabetes with hypertension are constantly increasing, and one of the main adverse effects of this disease is related to eyes. In this respect, the diagnosis of retinopathy, which is the same as identification of exudates, microanurysm and bleeding, is of particular importance. The results show that the proposed model is able to detect lesions in diabetic retinopathy images and classify them with an acceptable accuracy. In addition, the results suggest that this method has an acceptable performance compared to other methods.
Tayebeh Mirhashemi , Mehri Ghasemi , Frideh Dehghan-Manshadi , Alireza Akbarzadeh-Baghban , Alimohammad Faizi , Alireza Sabbaghian ,
Volume 76, Issue 5 (August 2018)
Volume 76, Issue 5 (August 2018)
Abstract
Background: Some studies show that frozen shoulder is due to the pathologic changes in the muscles around the shoulder. Measurement of the ultrasonic thickness of a muscle is a method for measuring the muscle changes. There is no study about the reliability of measurement of the muscle’s ultrasonic thickness around the shoulder in patients with frozen shoulder. The present study aims to investigate the intra-rater reliability of the ultrasonic thickness measurement of the supraspinatus, deltoid and upper trapezius muscles in women with frozen shoulder and healthy women.
Methods: This study was carried out during 4 months (June to October 2017). Twenty women consisted of 10 patients with frozen shoulder (mean age: 51.6±9.41 years) and 10 healthy subjects (mean age: 35.5±8.22 years) participated in this study. The patients from some clinics and hospitals in Tehran, and healthy subjects consisted of some personals and students in the School of Rehabilitation of Shahid Beheshti university of Medical Sciences participated in the present study. Measurements of ultrasonic thickness of the upper trapezius, supraspinatus and deltoid muscles in rest position carried out by the same rater two times in 48 hours. Ultrasonography instrument with linear probe (frequency: 7.5 MHz) were used for measurement of muscle thickness in millimeter.
Results: Reliability of the ultrasonic measurements of the muscle thickness in patients and healthy subjects was respectively as follow: The upper trapezius muscle (0.81, 0.81), the supraspinatus muscle (0.90, 0.92) and the middle deltoid muscle (0.93, 0.96). The reliability of the ultrasonic measurements of the muscle thickness for the upper trapezius muscle and the supraspinatus muscle was higher in healthy subjects compared to the patients with frozen shoulder. The reliability of the ultrasonic measurements of the middle deltoid thickness for the patients and healthy subjects was similar.
Conclusion: It seems that ultrasonography is a reliable method for measuring the thickness of the muscles around the shoulder in patients with frozen shoulder and healthy subjects.
Methods: This study was carried out during 4 months (June to October 2017). Twenty women consisted of 10 patients with frozen shoulder (mean age: 51.6±9.41 years) and 10 healthy subjects (mean age: 35.5±8.22 years) participated in this study. The patients from some clinics and hospitals in Tehran, and healthy subjects consisted of some personals and students in the School of Rehabilitation of Shahid Beheshti university of Medical Sciences participated in the present study. Measurements of ultrasonic thickness of the upper trapezius, supraspinatus and deltoid muscles in rest position carried out by the same rater two times in 48 hours. Ultrasonography instrument with linear probe (frequency: 7.5 MHz) were used for measurement of muscle thickness in millimeter.
Results: Reliability of the ultrasonic measurements of the muscle thickness in patients and healthy subjects was respectively as follow: The upper trapezius muscle (0.81, 0.81), the supraspinatus muscle (0.90, 0.92) and the middle deltoid muscle (0.93, 0.96). The reliability of the ultrasonic measurements of the muscle thickness for the upper trapezius muscle and the supraspinatus muscle was higher in healthy subjects compared to the patients with frozen shoulder. The reliability of the ultrasonic measurements of the middle deltoid thickness for the patients and healthy subjects was similar.
Conclusion: It seems that ultrasonography is a reliable method for measuring the thickness of the muscles around the shoulder in patients with frozen shoulder and healthy subjects.
Sepideh Haghifar , Yasaman Jamshidi Naeini , Mohammad Esmaeil Akbari , Morteza Abdollahi , Mahdi Shadnoush , Marjan Ajami , Sayed Hossein Davoodi ,
Volume 76, Issue 8 (November 2018)
Volume 76, Issue 8 (November 2018)
Abstract
Background: The average age of women with breast cancer in Iran is at least 10 years lower in comparison to developed countries and the incidence of the disease in Iranian women is on a rise. According to studies, diets that are diverse in food groups can play a role in protecting against chronic diseases including cardiovascular diseases and cancer. Diet diversity score is an indicator used to measure diversity between and within food groups. This study aimed to assess the relationship between diet diversity score and breast cancer risk.
Methods: This case-control study was carried out from April 2014 to February 2015 at Shohada Hospital in Tajrish, Tehran. Demographic and anthropometric data of 298 participants including 149 breast cancer cases and 149 apparently healthy women were collected. A valid food frequency questionnaire containing 168 food items was completed to assess usual dietary intake through face to face interviews. Energy was calculated using Nutritionist 4 software (First Databank Inc., Hearst Corp., San Bruno, CA, USA) and diet diversity score was calculated using five food group scoring. Odds ratios with 95% confidence intervals were obtained using logistic regression test to evaluate the association between breast cancer risk and diet diversity score tertiles.
Results: There was no significant difference in weight, height, body mass index between the two groups, but physical activity level and daily energy intake showed a significant difference (P<0.001). After adjusting for the effect of confounding variables including energy, body mass index, physical activity, menopause status, family history of breast cancer, contraceptive use, number of pregnancy, age of menarche and smoking, the risk for developing breast cancer was 86% lower in those in the highest tertile of diet diversity score compared to those in the first tertile (OR=0.14, 95% CI=0.06-0.31). An inverse and significant association was found between breast cancer risk and diversity scores of fruits and milk groups (P<0.001).
Conclusion: Higher diet diversity score is associated with reduced risk of breast cancer.
Methods: This case-control study was carried out from April 2014 to February 2015 at Shohada Hospital in Tajrish, Tehran. Demographic and anthropometric data of 298 participants including 149 breast cancer cases and 149 apparently healthy women were collected. A valid food frequency questionnaire containing 168 food items was completed to assess usual dietary intake through face to face interviews. Energy was calculated using Nutritionist 4 software (First Databank Inc., Hearst Corp., San Bruno, CA, USA) and diet diversity score was calculated using five food group scoring. Odds ratios with 95% confidence intervals were obtained using logistic regression test to evaluate the association between breast cancer risk and diet diversity score tertiles.
Results: There was no significant difference in weight, height, body mass index between the two groups, but physical activity level and daily energy intake showed a significant difference (P<0.001). After adjusting for the effect of confounding variables including energy, body mass index, physical activity, menopause status, family history of breast cancer, contraceptive use, number of pregnancy, age of menarche and smoking, the risk for developing breast cancer was 86% lower in those in the highest tertile of diet diversity score compared to those in the first tertile (OR=0.14, 95% CI=0.06-0.31). An inverse and significant association was found between breast cancer risk and diversity scores of fruits and milk groups (P<0.001).
Conclusion: Higher diet diversity score is associated with reduced risk of breast cancer.
Mahshad Ali Karoosi , Farideh Shishehbor , Karim Mola , Meysam Alipour ,
Volume 77, Issue 5 (August 2019)
Volume 77, Issue 5 (August 2019)
Abstract
Background: Obesity is one of the causes of onset and exacerbation of rheumatoid arthritis. However, limited studies have examined the association between body composition and severity of disease. The aim of this study was to evaluate the association between severity of rheumatoid arthritis with various types of obesity and the comparison of anthropometric indices between patients with rheumatoid arthritis and healthy subjects.
Methods: This case-control study was conducted on 95 patients (48.8±10.4 years) with rheumatoid arthritis as a case group and 95 healthy people (46±9.3 years) as a control group carried in Golestan Hospital, Ahvaz, Iran, from April 2016 to February 2017. Weight, height, waist circumference (WC), hip circumference (HC) and body fat percentage (BFP) were measured. The anthropometric indices were calculated. The disease severity was calculated according to disease activity score 28 (DAS28).
Results: There was no significant difference between two groups regarding their gender ratio (1:1), age (P=0.16) and height (P=0.58). The weight, body mass index (BMI), body fat (BF), WC, HC, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and other obesity indices include a body shape index (ABSI), body adiposity index (BAI), abdominal volume index (AVI), body surface area (BSA) and Conicity index (CI) in patients with rheumatoid arthritis are significantly higher than healthy subjects (P<0.05). No difference in fat free mass was observed between two groups. Waist to height ratio and BAI compared with other indicators had the highest correlation with the DAS28 score. In addition, prevalence of obesity by waist circumference (82% vs. 61%), obesity by BMI (47% vs. 33%), and obesity by BFP (91% vs. 83%) was higher in patients with rheumatoid arthritis than healthy subjects. The risk of rheumatoid arthritis in people with central obesity by waist circumference (OR=2.92, 95% CI 1.50-5.70) was greater than obesity defined by BMI (OR=1.77, 95% CI 0.98-3.18) or BFP (OR=2.37, 95% CI 1.01-5.53).
Conclusion: The results of present study indicate association of rheumatoid arthritis disease severity with obesity types (especially central obesity) and anthropometric indices.
Methods: This case-control study was conducted on 95 patients (48.8±10.4 years) with rheumatoid arthritis as a case group and 95 healthy people (46±9.3 years) as a control group carried in Golestan Hospital, Ahvaz, Iran, from April 2016 to February 2017. Weight, height, waist circumference (WC), hip circumference (HC) and body fat percentage (BFP) were measured. The anthropometric indices were calculated. The disease severity was calculated according to disease activity score 28 (DAS28).
Results: There was no significant difference between two groups regarding their gender ratio (1:1), age (P=0.16) and height (P=0.58). The weight, body mass index (BMI), body fat (BF), WC, HC, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and other obesity indices include a body shape index (ABSI), body adiposity index (BAI), abdominal volume index (AVI), body surface area (BSA) and Conicity index (CI) in patients with rheumatoid arthritis are significantly higher than healthy subjects (P<0.05). No difference in fat free mass was observed between two groups. Waist to height ratio and BAI compared with other indicators had the highest correlation with the DAS28 score. In addition, prevalence of obesity by waist circumference (82% vs. 61%), obesity by BMI (47% vs. 33%), and obesity by BFP (91% vs. 83%) was higher in patients with rheumatoid arthritis than healthy subjects. The risk of rheumatoid arthritis in people with central obesity by waist circumference (OR=2.92, 95% CI 1.50-5.70) was greater than obesity defined by BMI (OR=1.77, 95% CI 0.98-3.18) or BFP (OR=2.37, 95% CI 1.01-5.53).
Conclusion: The results of present study indicate association of rheumatoid arthritis disease severity with obesity types (especially central obesity) and anthropometric indices.
Razieh Nazari , Mehri Ghasemi , Farideh Dehghan-Manshadi , Alireza Akbarzadeh-Baghban ,
Volume 77, Issue 8 (November 2019)
Volume 77, Issue 8 (November 2019)
Abstract
Background: Rotator cuff injuries are the most common causes of shoulder pain and supraspinatus muscle is usually involved. Clinical tests are available and inexpensive tools for assessment of shoulder dysfunctions. The empty can (EC) and full can (FC) tests are considered as shoulder gold standard tests. Recently, hug up (HU) test has been developed to assess the supraspinatus. So far, no ultrasonographic study has compared supraspinatus muscle thickness in these testing positions. The present study aimed to compare the supraspinatus muscle thickness in the hug up testing position with the full can and empty can testing positions in young and healthy women.
Methods: Forty healthy women (mean age 21.62±2.4 years) participated in this cross-sectional-comparative study from April to June 2018 in the Biomechanic Laboratory of Rehabilitation School, Shahid Beheshti University of Medical Sciences in Tehran, Iran. The supraspinatus muscle thickness was scanned during rest and contracted states with a 0.5 Kg weight cuff. For contracted states, (A) EC testing position: the arm was at 90º abduction in the scaption plane with the thumb-down, (B) FC testing position: the arm was maintained at 90º abduction in the scaption plane with the thumb-up, (C) HU testing position: the palm of hand was placed on the opposite shoulder with the elbow flexed.
Results: The Bonferroni test showed significant differences (P<0.001) between the muscle thickness in the rest and the testing positions. The muscle thickness in the empty can testing position was significantly less than the full can testing position (P=0.001), no significant difference was found between the muscle thickness in the hug up testing position compared to the full can and empty can testing positions.
Conclusion: All of the empty can, full can and hug up testing positions demonstrated increased mean muscle thickness when compared to the rest position and the greatest muscle thickness was in the full can testing position. It seems that supraspinatus muscle thickness in hug up testing position is similar with empty can and full can testing positions.
Methods: Forty healthy women (mean age 21.62±2.4 years) participated in this cross-sectional-comparative study from April to June 2018 in the Biomechanic Laboratory of Rehabilitation School, Shahid Beheshti University of Medical Sciences in Tehran, Iran. The supraspinatus muscle thickness was scanned during rest and contracted states with a 0.5 Kg weight cuff. For contracted states, (A) EC testing position: the arm was at 90º abduction in the scaption plane with the thumb-down, (B) FC testing position: the arm was maintained at 90º abduction in the scaption plane with the thumb-up, (C) HU testing position: the palm of hand was placed on the opposite shoulder with the elbow flexed.
Results: The Bonferroni test showed significant differences (P<0.001) between the muscle thickness in the rest and the testing positions. The muscle thickness in the empty can testing position was significantly less than the full can testing position (P=0.001), no significant difference was found between the muscle thickness in the hug up testing position compared to the full can and empty can testing positions.
Conclusion: All of the empty can, full can and hug up testing positions demonstrated increased mean muscle thickness when compared to the rest position and the greatest muscle thickness was in the full can testing position. It seems that supraspinatus muscle thickness in hug up testing position is similar with empty can and full can testing positions.
Solmaz Ohadian Moghadam , Erfan Amini , Mohsen Ayati , Hassan Jamshidian , Seyed Ali Moemeni , Farshad Sheybaee Moghaddam , Mohammad Reza Nowroozi ,
Volume 77, Issue 10 (January 2020)
Volume 77, Issue 10 (January 2020)
Abstract
Background: Prostate cancer has been reported as a worldwide important kind of cancer and the second most common cause of cancer-related mortality among men. Prostate-specific antigen (PSA) serum level is one of the most important markers of prostate cancer diagnosis. While PSA level helps predict the risk of prostate cancer development, researchers still looking for ways to increase the accuracy of prognostic models. To increase the specificity of PSA and decrease of unnecessary biopsies and morbidity, PSA-related parameters such as PSA doubling time (PSADT) have been used. In this study, the relationship between this factor and the severity of prostate cancer was evaluated.
Methods: In this retrospective study, the data of patients who were subjected to transrectal ultrasound-guided (TRUS) biopsy of the prostate and referred to Imam Khomeini Hospital, Tehran, between 2009 and 2017 were reviewed. We enrolled the men with at least two consecutive elevated PSA level within three months to calculate PSADT. Based on the pathology report, primary and secondary Gleason score (GS) were determined. Correspondingly, considering GS, the patients were divided into two groups with high-grade and low-grade tumor (GS<7 considered as low-grade and GS>7 considered as high-grade tumor).
Results: Totally, 1712 cases of TRUS biopsy of the prostate were studied. Among them, 547 (32.3%) had prostate cancer, of whom 73 cases were eligible based on inclusion criteria and were consented to enroll in the study. According to the data obtained, we found a significant difference in PSADT between the two groups of patients with high-grade and low-grade malignancy (mean±SD PSADT, 9.8±14.2 vs. 16.1±14.9 respectively, P=0.004). Considering the seven months as the cut-off point for PSADT in determining malignancy, there was a significant difference between the two groups according to Fisher's exact test (P=0.01).
Conclusion: In our study, PSADT cut-off of 7 months provided the greatest accuracy for differentiation between low-grade and high-grade malignancy, and PSADT has acceptable accuracy for the diagnosis of high-grade tumors.
Methods: In this retrospective study, the data of patients who were subjected to transrectal ultrasound-guided (TRUS) biopsy of the prostate and referred to Imam Khomeini Hospital, Tehran, between 2009 and 2017 were reviewed. We enrolled the men with at least two consecutive elevated PSA level within three months to calculate PSADT. Based on the pathology report, primary and secondary Gleason score (GS) were determined. Correspondingly, considering GS, the patients were divided into two groups with high-grade and low-grade tumor (GS<7 considered as low-grade and GS>7 considered as high-grade tumor).
Results: Totally, 1712 cases of TRUS biopsy of the prostate were studied. Among them, 547 (32.3%) had prostate cancer, of whom 73 cases were eligible based on inclusion criteria and were consented to enroll in the study. According to the data obtained, we found a significant difference in PSADT between the two groups of patients with high-grade and low-grade malignancy (mean±SD PSADT, 9.8±14.2 vs. 16.1±14.9 respectively, P=0.004). Considering the seven months as the cut-off point for PSADT in determining malignancy, there was a significant difference between the two groups according to Fisher's exact test (P=0.01).
Conclusion: In our study, PSADT cut-off of 7 months provided the greatest accuracy for differentiation between low-grade and high-grade malignancy, and PSADT has acceptable accuracy for the diagnosis of high-grade tumors.
Abolghasem Pourreza, Ali Mohammad Mosadeghrad , Masoumeh Parvizi-Shad ,
Volume 78, Issue 5 (August 2020)
Volume 78, Issue 5 (August 2020)
Abstract
Background: Medical errors are those mistakes committed by healthcare professionals due to wrong execution of a planned healthcare action or execution of a wrong healthcare action plan whether or not it is harmful to the patient. Medical errors may cause patients to suffer and have huge financial costs for the healthcare system. Identifying and measuring medical errors and adverse events are essential for improving patient safety. The objectives of this research were to measure medical errors and adverse events rates, to identify their severity and also analyze their underlying causes in a general educational hospital in Tehran, Iran by using The Global Trigger Tool.
Methods: A descriptive, cross-sectional, and retrospective approach was used in this study. The medical records of 377 hospitalized patients between April 2015 and March 2016 were examined using simple random sampling method. Patient’s records were reviewed by a nurse using The Global Trigger Tool. Then, a physician authenticated the findings of the adverse events and rated their severity. The causes of adverse events were identified using brain storming and Ishikawa Cause And Effect Diagram.
Methods: A descriptive, cross-sectional, and retrospective approach was used in this study. The medical records of 377 hospitalized patients between April 2015 and March 2016 were examined using simple random sampling method. Patient’s records were reviewed by a nurse using The Global Trigger Tool. Then, a physician authenticated the findings of the adverse events and rated their severity. The causes of adverse events were identified using brain storming and Ishikawa Cause And Effect Diagram.
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Results: A total of 205 triggers were detected, and 60 adverse events were identified. About 15.9 percent of patients experienced an adverse event. The rate of adverse events was 19.1 per 100 admissions and 5.7 per 100 Admission days or hospitalization days. Almost half of the adverse events were in the E and F categories (temporary harm). Bleeding, nosocomial infections, and patient fall were the leading adverse events. Employees and working processes were the underlying causes of the medical errors and adverse events. The Global Trigger Tool found 100 times more adverse events than the voluntary reporting method.
Conclusion: The adverse event rate of this study was high. Hospital managers should take appropriate actions to reduce medical errors and adverse events and enhance patient safety. The Global Trigger is a Powerful, reliable, strong tool for identifying adverse events and measuring their severity. |
Reza Ershadi,
Volume 78, Issue 5 (August 2020)
Volume 78, Issue 5 (August 2020)
Abstract
Background: The bronchopulmonary carcinoid tumor accounts for 1-2% of all adult malignancies of the lung and 20-30% of all carcinoid tumors. Cushing’s syndrome is the result of chronic exposure to increased concentration of exogenous or endo-genus cortisol hormone, and it is generally associated with central obesity, metabolic syndrome, and hypertension. Treatment is based on decreasing cortisol levels in the blood, through medical or surgical approaches. Surgery is considered the main treatment for ectopic ACTH-secreting tumors. Paraneoplastic Cushing’s syndrome due to bronchopulmonary carcinoid tumor is a rare clinical occurrence, which has been reported in only a few case reports and case series. An average of 71% of typical carcinoid tumors were found to be central. 79% of patients with a peripheral carcinoid tumor and evidence of mediastinal node enlargement are likely to have an atypical carcinoid.
Case Presentation: A 45 Years old male with a history of ectopic Cushing’s syndrome over the last two years was admitted to our department (Department of thoracic surgery, Teahran, Iran). He had a positive Octreotide scan of the hilar lymph nodes of the left lung at last evaluations. During the surgery, in the left lower lobe was resected (because a small nodule with tumoral appearance was seen in left lower lobe) with hilar and mediastinal lymph node dissection. Pathology indicated a typical carcinoid tumor with mediastinal lymph node metastasis. Plasma cortisol and ACTH were normalized following the surgery.
Case Presentation: A 45 Years old male with a history of ectopic Cushing’s syndrome over the last two years was admitted to our department (Department of thoracic surgery, Teahran, Iran). He had a positive Octreotide scan of the hilar lymph nodes of the left lung at last evaluations. During the surgery, in the left lower lobe was resected (because a small nodule with tumoral appearance was seen in left lower lobe) with hilar and mediastinal lymph node dissection. Pathology indicated a typical carcinoid tumor with mediastinal lymph node metastasis. Plasma cortisol and ACTH were normalized following the surgery.
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Conclusion: The present study reported a rare case of Cushing paraneoplastic syndrome with typical bronchopulmonary carcinoid tumor and N2 lymph node metastasis. The high prevalence of lymph node involvement confirms the aggressive nature of these tumors and warrants complete anatomic resection with radical lymphadenectomy.
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Samaneh Assarzadeh, Shirin Sadat Badri, Sakinah Haddad , Marjan Mansourian, Shadi Farsaei, Saeed Abbasi,
Volume 78, Issue 8 (November 2020)
Volume 78, Issue 8 (November 2020)
Abstract
Background: Intravenous (IV) injection of drugs is one of the most common methods of drug prescription in hospitals, which is a complex, potentially hazardous and erroneous method; accordingly, it requires control methods to reduce the potential risks. This study focused on determining the frequency and types of different medication errors while preparing and administering mostly used IV drugs in three intensive care units (ICU) and one general department in AL-Zahra hospital, Isfahan, Iran.
Methods: This cross-sectional observational study was conducted for 6 months from September 2017 to March 2018. To determine the frequency of different medication errors, a quoting sampling method was applied to select and observe 400 cases of IV drug administrations. All nurses from any studied department were included in this study. Different stages of preparation and administration of the observed drugs were compared to an instructed checklist prepared by the clinical pharmacist.
Methods: This cross-sectional observational study was conducted for 6 months from September 2017 to March 2018. To determine the frequency of different medication errors, a quoting sampling method was applied to select and observe 400 cases of IV drug administrations. All nurses from any studied department were included in this study. Different stages of preparation and administration of the observed drugs were compared to an instructed checklist prepared by the clinical pharmacist.
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Results: Totally, 75 nurses were recruited from ICU-1 (N=29), ICU-2 (N=18), ICU-3 (N=19), and nephrology (N=9) departments. Type of department and occupation were the influential factors on nursing errors; also, a significant relationship was found between different work shifts and the occurrence of nurses’ errors, mostly seen in the evening work shift (P=0.037). The mean of nurses’ errors in IV drug administration was not correlated with other factors including age, work history, and the number of patients managed by each one. Also, a positive correlation was found between the number of nurses in each work shift and the number of errors (P=0.008).
Conclusion: Medication errors in each stage of drug administration may lead to the hazardous clinical outcome or serious side effects such as thrombosis, infection or eventually lead to morbidity or mortality. Therefore, being aware of these errors and establishing observational policies can prevent unpleasant events related to drug administration. |
Hamed Behrad, Mahdi Zareei , Zeinab Borjian Boroujeni , Seyed Saeed Asadi, Zeinab Tabanejad , Mohammad Panji, Masoud Asgharpour-Arshad ,
Volume 78, Issue 10 (January 2021)
Volume 78, Issue 10 (January 2021)
Abstract
Life expectancy has increased throughout the world and, as a result, the population of the elderly is also rising. From the age of 30 years old, the human body mass loses about 0.1 to 0.5% of its skeletal muscle mass annually, which is accelerated after the age of 65 years old. Aging is characterized by a decrease in the progression of musculoskeletal and physical activity known as sarcopenia. Sarcopenia has a complex molecular pathogenesis that includes age-related changes in muscles’ neuromuscular activity, muscle protein replacement, the hormone levels and the related sensitivity of human body to these mentioned factors. The pathogenic conditions and other disorders in sarcopenia are the chronic inflammatory states that include oxidative stress and changes in behavioral factors, especially in nutritional status and physical activity. By definition of the European Working Group on Sarcopenia in Older People (EWGSOP), the diagnosis of sarcopenia is determined by the presence of two main factors which are low muscle mass and low muscle function. Besides, specific sarcopenia-related biomarkers have been identified for early diagnosis and accurate identification of the main pathophysiology mechanisms involved in the development of the disease. Since sarcopenia has adverse outcomes on public health in terms of behavioral factors, frailty, hospitalization and mortality of people, it is an important necessity for the social health system to plan some therapeutic approaches to prevention. The main and more important of these therapeutic approaches have known as exercises, nutritional supplements and hormonal therapies. Also, other new therapeutic strategies are under investigation to be introduced in the future. However, currently, it has been shown that only physical exercise has a positive effect on the controlling and prevention of sarcopenia and its adverse effects on human and public health. However, the role of appropriate nutrition is also effective. Therefore, carefully designed studies in terms of better utilization of physical activity are needed to achieve useful therapeutic results for sarcopenia management. Thus, this survey aims to review the other considerable studies on the pathogenesis, appropriate evaluation of the disease and treatment options for sarcopenia.
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